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  1. Mason, Diana J. PhD, RN, FAAN, AJN Editor-in-Chief

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Early in my relationship with my husband, James Ware, he would often sit quietly during an argument as I made my point-sometimes so quietly that I'd accuse him of not listening. Then, instead of directly refuting my point, he'd tell a long, richly detailed story. Impatient, I'd interrupt with, "What's this got to do with our argument?"


After I'd known him about three years, I realized: James and I differ in our communication styles because our ethnic backgrounds and occupations differ. I am a white nurse and editor of European descent grounded in the logical positivism of Western science. My husband is an African-American and Cherokee composer of jazz, an art form rooted in improvisation. Over the years I've come to appreciate his storytelling as a part of his heritage-one that enriches both his music making and our communicating.


I'm not sure why it took so long for me to appreciate his stories; nurses often use stories to raise issues, define problems, and illustrate solutions-sometimes too often because they don't know how to use data to support their concerns. Nurses told stories for years about poor outcomes resulting from heavy patient loads, but it took hard data to turn the heads of policymakers and administrators and make staffing ratios a national concern.


Some nursing "thought leaders," faculty, and researchers have criticized nurses' reliance on anecdotes as a way to convince others about the need for change. But the desire to advance nursing science sometimes causes us to dismiss the role and power of stories in a society that increasingly quantifies human experience. Storytelling is seen as unsophisticated and unworthy of nursing, especially because nurses have been trying so desperately to gain respect as a scientific discipline, under the assumption that such respect will earn us a greater role in health care decision making.


But storytelling is not the shameful little sister of science. Stories can show policymakers and administrators the impact of their decisions and can be part of error analysis. Patients write in journals to find meaning in their illnesses and to promote healing. And a growing number of nurses are writing narratives about their work to better understand what constitutes expert practice and for promotions.


So how can nurses more fully express their storytelling powers?


Carefully consider when to use stories, when to use data, and when to use both. By putting a human face on health care, stories can draw attention to problems that cry out for a policy response. In October, Health Affairs, the leading health policy journal published by Project Hope, sponsored a conference on narrative writing for nurses. This bimonthly journal reaches policymakers with data-based articles, commentaries, and a section called "Narrative Matters." (Unfortunately, Health Affairs has received few submissions from nurses for "Narrative Matters.") Be prepared to back up your story with data, if available, or lead with data and have an illustrative story ready.


Tell your stories in rich detail. Irene Wielawski, a journalist, challenged my belief that journalists don't try to interview nurses when writing news articles. She said that while covering the tragic fire at a Rhode Island nightclub in February, she was told that the burn victims' survival depended on the replacement of fluid and that this is nurses' first priority. She asked repeatedly to speak to a nurse working with the burn victims. Most would not speak to her. Finally, one did but only wanted to talk about how proud she was to be on the burn team and had to be coaxed into talking about the science of fluid replacement. "It took way too much effort," she says. "I saw her as an essential player, but she needed to be convinced. I could have been forced by deadline to give up."


What good are our stories if we don't use them to raise important issues in the right venues with the right people? If we reduce what we do to mere numbers, what will we really know about health, illness, and nursing?